Determinants of Use of Insecticide Treated Nets for the Prevention of Malaria in Pregnancy: Jinja, Uganda

Sangaré, Laura; Weiss, Noel S.; Brentlinger, Paula E.; Richardson, Barbra A.; Staedke, Sarah G.; Kiwuwa, Mpungu Steven; Stergachis, Andy

doi:10.1371/journal.pone.0039712

Cited by 51 publications

(53 citation statements)

References 35 publications

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“…The respondents stated reasons such as discomfort due to heat from the net and difficulty of hanging the nets as challenges in using ITNs. These observations are similar to findings in other studies in Africa [14, 20, 26–29]. More aerated materials other than polyester may help to enhance ventilation through hung ITNs.…”

Section: Discussionsupporting

confidence: 91%

Low Utilization of Insecticide-Treated Bed Net among Pregnant Women in the Middle Belt of Ghana

Manu

Boamah-Kaali

Febir

et al. 2017

Malaria Research and Treatment

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Background Malaria in pregnancy leads to low birth weight, premature birth, anaemia, and maternal and neonatal mortality. Use of insecticide-treated nets (ITNs) during pregnancy is one of the proven interventions to reduce the malaria burden. However, Ghana has not achieved its target for ITN use among pregnant women. Methods A qualitative study was conducted in seven communities purposively selected from the middle belt of Ghana. Participants who had delivered in the six months prior to this study were selected. In all, seven focus group discussions and twenty-four in-depth interviews were conducted between June and August 2010. Results Respondents knew of the importance of ITNs and other malaria-preventive strategies. Factors such as financial access and missed opportunities of free distribution denied some pregnant women the opportunity to own or use an ITN. Reasons for not using ITNs during pregnancy included discomfort resulting from heat, smell of the net, and difficulty in hanging the net. Participants maintained their ITNs by preventing holes in the nets, retreatment, and infrequent washing. Conclusion Pregnant women know about the causes and prevention of malaria. However, this knowledge is not transformed into practice due to lack of access to ITNs and sleeping discomforts among other logistical constraints.

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Section: Discussionsupporting

confidence: 91%

Low Utilization of Insecticide-Treated Bed Net among Pregnant Women in the Middle Belt of Ghana

Manu

Boamah-Kaali

Febir

et al. 2017

Malaria Research and Treatment

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“…Some studies reported similar findings [7,18,19], while the others showed significant associations between socio-economic factors and ITN use [11,12]. The presence of prominent vector breeding site yielding varying risk to the households in the study area was worthy of note since the households located closer to the vector breeding site reported more frequent use of ITNs, implying influence of nuisance mosquitoes and/or risk perception might have outweighed factors such as education and wealth, with regard to sleeping under ITNs.…”

Section: Discussionsupporting

confidence: 64%

Freely distributed bed-net use among Chano Mille residents, south Ethiopia: a longitudinal study

Loha

Tefera

Lindtjørn

2013

Malar J

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BackgroundA huge discrepancy was reported between ownership versus utilization of insecticide-treated bed nets (ITNs). To acquire the benefits of ITNs, households need to use and not merely own them. The objective of this study was to characterize the pattern of, and assess factors related to ITN use in one village in south Ethiopia.MethodsA prospective cohort study involving 8,121 residents (in 1,388 households) was carried out from April 2009 to April 2011 (101 weeks). Every week, individuals were asked whether they slept under an ITN the night before the interview. Descriptive statistics was used to report the availability and use of ITN. A negative, binomial, probability, distribution model was fitted to find out significant predictors of ITN use. Reasons for not using ITN were summarized.ResultsThe total number of ITNs available at the beginning of the study was 1,631 (1.68 ITNs per household). On week 48, 3,099 new ITNs (PermaNet2.0) were distributed freely (2.3 ITNs per household). The number of households who received at least one new ITN was 1,309 (98.4%). The percentage of children <5 years and pregnant women not using ITNs exceeded that of other adults. The mean (range; SD) ITN use fraction before and after mass distribution was 0.20 (0.15-0.27; 0.03) and 0.62 (0.47-0.69; 0.04), respectively. Before mass ITN distribution, the most frequent reason for not using ITN was having worn out bed nets (most complained the bed nets were torn by rats); and after mass ITN distribution, it was lack of convenient space to hang more than one ITN. Males, younger age groups (mainly 15–24 years) and those living away from the vector-breeding site were less likely to use ITN.ConclusionsThe ITN use fraction reached to a maximum of 69% despite near universal coverage (98.4%) was achieved. Gender, age differences and distance from vector breeding site were associated with ITN use. Strategies may need to be designed addressing disproportions in ITN use, lack of convenient space to hang more than one ITN (for those receiving more than one), and measures to prolong usable life of ITNs.

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“…to medicate without clinical symptoms, testing and diagnosis, particularly against a backdrop of Test Treat and Track for malaria [16]. A patient’s own decision-making around treatment can be complex and challenging [17], as can that of a patient’s or child’s caregiver [18] despite being ‘risk aware’, and motivated towards their welfare. Values such as a caregiver’s priorities (work vs. ensuring a child is well), life philosophy (treat to protect), self-efficacy (perceived ability) and background (malaria is a risk presented to all) are all likely to contribute to decision-making [17].…”

Section: Discussionmentioning

confidence: 99%

Facilitators and Barriers to Uptake of an Extended Seasonal Malaria Chemoprevention Programme in Ghana: A Qualitative Study of Caregivers and Community Health Workers

et al. 2016

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BackgroundSeasonal Malaria Chemoprevention (SMC) is currently recommended for children under five in areas where malaria transmission is highly seasonal. We explored children’s caregivers’ and community health workers’ (CHWs) responses to an extended 5-month SMC programme.MethodsThirteen in-depth interviews and eight focus group discussions explored optimal and suboptimal ‘uptake’ of SMC to examine facilitators and barriers to caregivers’ uptake.ResultsThere did not appear to be major differences between caregivers of children with optimal and sub-optimal SMC uptake in terms of their knowledge of malaria, their perceptions of the effect of SMC on a child’s health, nor their understanding of chemoprevention. Caregivers experienced difficulty in prioritising SMC for well children, perceiving medication being for treatment rather than prevention. Prior to the study, caregivers had become accustomed to rapid diagnostic testing (RDT) for malaria, and therefore blood testing for malaria during the baseline survey at the start of the SMC programme may have positively influenced uptake. Facilitators of uptake included caregivers’ trust in and respect for administrators of SMC (including CHWs), access to medication and supportive (family) networks. Barriers to uptake related to poor communication of timings of community gatherings, travel distances, absence during SMC home deliveries, and limited demand for SMC due to lack of previous experience. Future delivery of SMC by trained CHWs would be acceptable to caregivers.ConclusionA combination of caregivers’ physical access to SMC medication, the drug regimen, trust in the medical profession and perceived norms around malaria prevention all likely influenced caregivers’ level of uptake. SMC programmes need to consider: 1) developing supportive, accessible and flexible modes of drug administration including home delivery and village community kiosks; 2) improving demand for preventive medication including the harnessing of learnt trust; and 3) developing community-based networks for users to support optimal uptake of SMC.

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Determinants of Use of Insecticide Treated Nets for the Prevention of Malaria in Pregnancy: Jinja, Uganda

Cited by 51 publications

References 35 publications

Low Utilization of Insecticide-Treated Bed Net among Pregnant Women in the Middle Belt of Ghana

Low Utilization of Insecticide-Treated Bed Net among Pregnant Women in the Middle Belt of Ghana

Freely distributed bed-net use among Chano Mille residents, south Ethiopia: a longitudinal study

Facilitators and Barriers to Uptake of an Extended Seasonal Malaria Chemoprevention Programme in Ghana: A Qualitative Study of Caregivers and Community Health Workers

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